Provider Demographics
NPI:1689945057
Name:HOLLENBERG, EDITH N (OD)
Entity Type:Individual
Prefix:DR
First Name:EDITH
Middle Name:N
Last Name:HOLLENBERG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:EDY
Other - Middle Name:N
Other - Last Name:HOLLENBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:18000 GROSCHKE RD.
Mailing Address - Street 2:D-2
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084
Mailing Address - Country:US
Mailing Address - Phone:281-492-8018
Mailing Address - Fax:281-492-9687
Practice Address - Street 1:18000 GROSCHKE RD.
Practice Address - Street 2:D-2
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084
Practice Address - Country:US
Practice Address - Phone:281-492-8018
Practice Address - Fax:281-492-9687
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5678T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist